The mismatch sign is thought to reflect microcystic changes,43 and has been found only in lower grade gliomas.41 Although specificity is high, suggesting that the T2-FLAIR mismatch sign is a reliable indicator of IDH-mutant 1p19q intact astrocytomas, the sensitivity is variable and effect on clinical course is uncertain.40,42. This evidence concerns the gene IDH1 and central nervous system cancer.